Women groups and Civil Society Organisation Representatives in Nigeria have urged the Lagos State Governor Babajide Sanwo-Olu to immediately lift the suspension on the Guidelines on Safe Termination of Pregnancy for Legal Indications, else they will take up space at the government secretariat, Alausa, Ikeja, Lagos State.
The women stated their stance on the 22nd of July 2022, at a press conference, through the Executive Director of Women Advocates Research and Documentation Centre (WARDC), Dr. Abiola Akiyode-Afolabi.
Reading the statement, which was signed on behalf of 150 Women Rights and Civil Society Organisations, Akiyode-Afolabi said that unsafe abortion accounted for a high number of maternal deaths in Nigeria.
According to the women groups, 10 percent of the global maternal death rate comes from unsafe abortions in Nigeria, making it the second leading cause of maternal mortality in the country.
Akiyode-Afolabi added: “This is a neglected major area of preventable maternal deaths due to provisions of Nigerian Abortion Laws. Nigeria is yet to reform restrictive domestic laws and policies that place women and girls’ health and lives at risk and prevent them from exercising their reproductive rights which the Nigerian government has been committed to under international law. In 2017, 212,000 women out of two million annually estimated to have had abortions were treated for complications while 285,000 never received treatments for the severe health consequences they faced. Nigeria is obligated to implement the 2030 Global Sustainable Development Goals agreed by world governments at the United Nations in September 2015, with a target of universal access to sexual and reproductive healthcare services. The current abortion law in Nigeria was instituted by the British Offences Against Persons Act, Section 58, in the 19th century and has not been repealed or amended.”
She explained that in 2011, the Lagos State House of Assembly amended its Criminal Code to Criminal Law of Lagos State 2011 which has four relevant sections on abortion, Sections 145 provides for attempts to procure abortion, 146 provides for attempts to procure own’s miscarriage, 147 provides for Supplying drugs and instruments to procure abortions and 201 provides for Medical Abortion.
She further stated: “The Lagos State Guidelines on Safe Termination of Pregnancy for Legal Indications is modeled after the National Guidelines for Legal Indications (2018) prepared by the Federal Ministry of Health to provide guidance to medical practitioners and other stakeholders on when it is lawful or unlawful to do any acts qualified by the use of the word “unlawful” in sections 145,146,147 and 201. A person cannot be arrested for a medical abortion validated by Section 201 of Criminal Law of Lagos State. This provision expands the scope of the law beyond the scope of the law under the repealed Criminal Code. The new law provides two lawful grounds for which abortion is carried out: preservation of a mother’s life and preservation of a woman’s physical health. The reduction of unsafe abortions as a strategy for improving maternal health and reducing the alarming rate of deaths is crucial.”
Akiyode-Afolabi also maintained that on June 29, 2022, the Lagos State Government presented and launched the 40-page policy document titled ‘Lagos State Guidelines on Safe Termination of Pregnancy for Legal Indicators’ to set out guidelines for safe termination of pregnancy within the ambit of the Criminal Law of Lagos State.
This guideline, said the activist, was to standardise and build capacity for medical professionals to save the lives of pregnant women whose pregnancy continuation was a danger to their lives and physical health.
“This outcome ensured that safe abortion services were available within legal indications in Lagos, also domesticating the Violence against Persons Prohibition Act, Section 38. It supports victims of rape and sexual violence in receiving comprehensive medical care. Unfortunately, the Lagos State Government on July 8, 2022, ordered the suspension of the ‘State Guidelines on Safe Termination of Pregnancy for Legal Indications’ issued by the Directorate of Family Health and Nutrition in the state’s ministry of health. Some religious, cultural, and persons with certain philosophical convictions have kicked against the document that was developed over four years. Through painstaking work by experts in Law and in Obstetrics and Gynaecology, it has created an opportunity to reduce maternal mortality in line with existing laws. The Guidelines recognise the following legal indications; Obstetrics and Gynaecological Conditions, Heart and Vascular Diseases, Kidney Diseases, Cancers, Blood Diseases, Psychiatric and other Mental Disorders and other conditions.”
Akiyode-Afolabi, who believes in women’s reproductive rights, said that the denial of safe abortion care to survivors of rape violated the right to health and privacy and may violate the prohibition of ill-treatment.
She noted: “Nigeria is bound by the provisions of Maputo Protocol which is the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa. It is the main legal instrument for the protection of the rights of women and girls in Africa. Article 14 of the Maputo Protocol guarantees women’s right to health, including sexual and reproductive health. Under Article 14 (2) (c) of the Maputo Protocol, States Parties are called upon to take all appropriate measures to ‘protect the reproductive rights of women by authorizing medical abortion in cases of sexual assault, rape, incest, and where the continued pregnancy endangers the mental and physical health of the mother or the life of the mother or the foetus.’”
She said that the Lagos State Guidelines on Safe Termination of Pregnancy for Legal Indications details safe therapeutic abortion methods. “It defines therapeutic abortion as a termination of a pregnancy, performed when the pregnancy endangers the mother’s life, physical or mental health, or when the foetus has a condition incompatible with normal life. Methods of safe therapeutic abortion include the following: the medical method, which is the use of pharmacological drugs to terminate a pregnancy. The Guidelines also list Mifepristone and Misoprostol which are included in the World Health Organization’s list of essential medicines. It also gives a breakdown of dosages to be used at which pregnancy duration, likely side effects like nausea, diarrhoea and lists which health risk conditions are not compatible with medication usage.”
It also includes the surgical method, which is the use of trans-cervical procedures to terminate a pregnancy. These procedures, said the Akiyode-Afolabi, include manual vacuum aspiration, dilatation and evacuation and electric vaccine aspiration.
The Guidelines argued Akiyode-Afolabi, list and tabulate detailed procedures for the surgical procedures and recommended which method of therapeutic abortion was best suitable for legal indicated medical conditions.
She continued: “Noteworthy parts of the Guidelines are its stipulated pre-procedure care and post-procedure care. These ensure any and every complication before, during and after medical care is identified and addressed. Post Procedure Care includes After-care observations, monitoring details of post-procedure complications, and considering and referring to psychological and emotional support. Assist client to obtain correct information on family planning and contraceptive planning and lastly follow up. This will help achieve the goal to reduce the incidence of repeated unintended pregnancy and unsafe abortions. Monitoring and Evaluation of services of safe termination of pregnancy require health care providers to fill Form 6a, Form 6b and a list to record, evaluate and report to the Central Health Management Information Centre.”
She mentioned that several international organisations such as the World Health Organization, the International Federation of Gynaecologists and Obstetricians, Amnesty International, United Nations and Royal College of Obstetricians and Gynaecologists had repeatedly issued guidelines to indicate women have a right to decide on whether to have an abortion.
“It is her body; it should be her choice! One of the long-term outcomes of the Guidelines is to ensure reproductive choice for women faced with unintended pregnancy. The development and dissemination of the policy document showed Lagos leading state-level intervention on unsafe abortion while giving women and girls improved healthcare. It cannot be over-emphasized that the Guidelines need to be passed and not withdrawn,” said Akiyode-Afolabi.
The group, therefore, called on “ the Lagos State Government to immediately lift the suspension on the guidelines, we believe that the state government is being blackmailed by religious sentiments, women have a right to their bodily integrity and to live what the guidelines are pushing for us to save women from a good preventable death. The suspension on the Guidelines on Safe Termination of Pregnancy for Legal Indications should immediately be lifted.”
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